Changes in Bone Quality Sarcopenia and Fat Distribution in HIV/HCV Patients after HCV Therapy

Coinfection with hepatitis C virus (HCV) is common among HIV infected patients. HIV exacerbates HCV-related metabolic complications, and coinfected patients have a higher risk of sarcopenia, visceral adiposity, hepatic steatosis, and bone fracture than those with HCV alone, HIV alone, or uninfected persons. Understanding these associations in HIV+/HCV+ patients, how they differ from those of HCV+ and uninfected persons, and their relations with levels of inflammatory cytokines and insulin-like growth factor-1 (IGF-1) will shed light on the relations between HIV/HCV infections and musculoskeletal health, fat distribution, and the role of inflammation. It is unknown if HCV cure with direct-acting antiviral (DAA) therapy ameliorates these abnormalities, and if the degree of improvement is similar for HIV+/HCV+ and HCV+ patients. We will assemble three cohorts: 1) HCV treatment-naïve HIV+/HCV+ coinfected patients initiating DAA therapy, 2) treatment-naïve HCV+ monoinfected patients initiating DAA therapy, and 3) uninfected persons. We will prospectively follow both HCV infected cohorts from the start of DAA therapy through 12 months after cure of HCV (18-month period) and the uninfected cohort over 18 months. Aim 1 will compare muscle mass; muscle strength; subcutaneous, visceral, and intra-hepatic fat; and bone microarchitecture/strength across the cohorts at enrollment and evaluate the cytokines and IGF-1 as determinants of these outcomes. Aim 2 will examine the effect of cure of HCV with DAAs on the cytokine and IGF-1 levels in HIV+/HCV+ and HCV+ patients and their associations with subsequent changes in muscle, fat, and bone compared to changes in uninfected persons over the same time.